PROJECT SUMMARY/ABSTRACT Acute coronary syndrome (ACS) is a potentially life-threatening emergency, and rapid diagnosis and life-saving reperfusion therapies are essential to prevent devastating patient outcomes. Dr. Zgre-Hemsey has extensive clinical experience in the emergency department (ED), where she became committed to improving outcomes for patients with ACS. In her dissertation research, she investigated prehospital electrocardiography (ECG) to improve early diagnosis of ACS, which provided a foundation for the proposed study of patient-reported symptoms and outcomes in her emerging program of emergency cardiac care research. The mentored K23 award is the logical next step to support Dr. Zgre-Hemsey?s long-term goal of becoming an independent cardiovascular nurse scientist, and her outstanding mentoring team will be pivotal to her career development. Dr. Wayne Rosamond (primary) is a professor and preeminent researcher in cardiovascular epidemiology and emergency medical services (EMS) research. He has an extensive history of sustained funding and successful mentorship of numerous junior faculty. Dr. Holli DeVon (co-mentor), is a professor of nursing and expert on symptoms and sex differences in ACS with a strong record of extramural funding and successful mentorship of predoctoral and postdoctoral fellows and junior faculty. In the proposed research, Dr. Zgre-Hemsey will acquire new skills in symptom science and mixed-methods research through coursework, mentoring, and active engagement with established research teams. Using a mixed-methods design, she will investigate how outcomes vary by symptoms in the prehospital period (i.e., symptom onset to ED arrival) in adults transported by ambulance for suspicion of ACS. Specific aims are to: 1) examine the occurrence, severity, and changes in symptoms from prehospital period (Time 1) to ED (Time 2) and evaluate symptom clusters, using the ACS Symptom Checklist; 2) determine if symptoms suggestive of ACS predict adverse patient and clinical outcome; 3a) describe reports of symptoms on 911 call recordings (qualitative aim); and 3b) patterns of symptoms, clusters, and outcomes using mixed-methods techniques (integrated aim). The study will be implemented with a sample recruited from Orange County EMS in North Carolina and transported to the University of North Carolina Hospital, a large academic medical center with an outstanding program in emergency cardiac care. Study results will provide evidence of how symptoms relate to patient and clinical outcomes in patients with suspicious ACS. Results will advance knowledge of symptom science and provide the data to develop future patient-centered interventions in emergency cardiac care. Knowledge from this award will be used for an R-level proposal, to be submitted in Year 3. This patient-oriented study supports NINR?s Strategic Plan to advance symptom science and innovative care delivery models to change chronic illness trajectories. The likely long- term impact of this research is a change in clinical practice resulting in improved survival, functional status, and quality of life for ACS patients in the United States and globally.